Getting pregnant when you're over 40

Q: My wife and I have been married for two years (we are in our mid-40s and in good health) and are trying to have a baby. However, nothing has happened. Can anything help in our case? Please let us know what you recommend; we will try anything.

A: I wish you good luck in the quest for pregnancy. Unfortunately, just being in her 40s makes it harder for your wife to conceive, no matter how healthy she is otherwise. Because it sounds as if you have been trying for a while, I would suggest you do some investigating.

First, although men usually remain fertile well beyond the 40s, I would recommend that you have a semen analysis to see how healthy your sperm look. Your physician or your wife’s gynecologist can order this test. Because about 40 percent of all cases of infertility arise from male factors, you should check it out with this easy test. (All it involves is collecting an ejaculate after refraining from intercourse for two days, and then taking the ejaculate to a lab.)

To help assess your wife’s fertility status, I would suggest that she have a blood test to measure her follicle-stimulating hormone (FSH) level on the third day of her period. If she has an FSH level lower than 20, she probably has a reasonable number of eggs left in her ovaries. She might also want to have her progesterone level measured by getting her blood tested again four or five days before her period is due. This test will reflect how well she is ovulating, or producing eggs. An ovulation problem is the most common reason for a woman older than 40 not being able to conceive. There are safe medications available to help women ovulate better. (I needed some help to conceive my son, although I was only 38.) The only major drawback to these ovulation enhancers is the risk of multiple gestations (the vast majority of which are twins), which occur 6 percent of the time when using clomid, the most commonly used drug.

Even if the ovarian reserve is poor and it appears that the ovary cannot respond well to ovulation helpers, there is always the possibility of using donor eggs. Healthy women in their 40s do quite well with obtaining a donor egg from a younger woman, using sperm from their own husbands, and carrying the pregnancy. But you are very far away from making that decision.

I would suggest that you talk with a gynecologist who takes care of infertility problems, or a subspecialist in the field of reproductive endocrinology and infertility. But I would do it soon, rather than just waiting several more years, because time here is very important.

What you have in your mind?